Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02365 | Date 27/06/2019 |
| Token No | SM/18-19/4493 27/06/2019 | Serial | 026 |
| Patient Name | Miss RENU DEY | Contact No | NOT GIVEN |
| Address | 10 NO RAM PANDIT LANE | Age | 19 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||